Healthcare Provider Details

I. General information

NPI: 1871200139
Provider Name (Legal Business Name): 200FLY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2022
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4255 ROUTE 9 N STE 5C
FREEHOLD NJ
07728-8305
US

IV. Provider business mailing address

4255 ROUTE 9 N STE 5C
FREEHOLD NJ
07728-8305
US

V. Phone/Fax

Practice location:
  • Phone: 732-400-5434
  • Fax: 732-702-2462
Mailing address:
  • Phone: 732-400-5434
  • Fax: 732-702-2462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. WAYNE ESPIRITU
Title or Position: PRESIDENT
Credential:
Phone: 732-400-5125